Cardiac Anatomy - Hoagland

Question 1

What causes cardiac tamponade? What are the symptoms?

Answer 1

Cardiac tamponade is caused by effusion into the pericardial sac.

• Venous Hypertension
• Pulmonary Artery Hypertension
• Tachypnea
• Tachycardia
• Narrowing of BP

Question 2

What causes the venous hypertension in cardiac tamponade?

Answer 2

Increased pressure in the pericardial sac restricts the expansion of the ventricle and decreases output. This leads to a back-up in the venous system and hypertension.

Question 3

What causes the pulmonary artery hypertension in cardiac tamponade?

Answer 3

Increased pressure in the pericardial sac restricts the expansion of the ventricle and decreases output. This leads to a back-up in the pulmonary artery and hypertension.

Question 4

What causes the tachypnea in cardiac tamponade?

Answer 4

The pulmonary hypertension causes pleural effusion, which decreases available oxygen exchange area, requiring increased breathing.

Question 5

What causes the tachycardia in cardiac tamponade?

Answer 5

The increased pericardial pressure decreases cardiac output. Because metabolic requirements are static, heart rate must increase.

Question 6

What causes the blood pressure narrowing in cardiac tamponade?

Answer 6

The increased pericardial sac pressure decreases left ventricle output. This drops the systemic blood pressure and leads to narrowing of the blood pressure.

Question 7

Where would you auscultate the aortic valve?

Answer 7

Immediately to the right of the sternum, in the second intercostal space.

Question 8

Where would you auscultate the pulmonary valve?

Answer 8

Immediately the to left of the sternum, in the second intercostal space.

Question 9

Where would you auscultate the tricuspid valve?

Answer 9

Immediately to the left of the sternum, in the fifth intercostal space.

Question 10

Where would you auscultate the mitral valve?

Answer 10

In the fifth intercostal space, on the mid-clavicular line.

Question 11

Where on an x-ray would you see the aortic knob?

Answer 11

To the (patient’s) left of midline, right below the clavicle.

Question 12

What structures are most likely to be injured from a ventral penetrating injury?

Answer 12

The right ventricle or atrium, depending on whether the penetration happened right (atrium) or left (ventricle) of the sternum.

Question 13

How would you most likely injure the left ventricle or left atrium?

Answer 13

A dorsally or laterally penetration injury

Question 14

What borders the heart?

Answer 14

Laterally -lungs and the phrenic nerve
Anterior- sternum, ribs
Posterior- trachea superiorly, esophagus
Inferiorly-Diaphragm

Question 15

What arteries branch off of the aorta?

Answer 15

Right brachiocephalic
Left common carotid
left subclavian

Question 16

What arteries branch off of the right brachiocephalic?

Answer 16

Right subclavian

Right common carotid

Question 17

What nine places can be used to take a pulse?

Answer 17

Superficial Temporal (temple)
Facial (lateral jawline)
Carotid (neck)
Subclavian (above clavicle)
Brachial (upper arm)
Radial (wrist)
Femoral (medial inguinal crease)
Popliteal (back of knee)
Dorsalis Pedis (between first and second metatarsal)

Question 18

What are the three layers of the pericardium?

Answer 18

Moving superficially:
visceral serous pericardium
parietal serous pericardium
fibrous pericardium

Question 19

Where is the pericardial cavity?

Answer 19

Between the visceral serous pericardium and the parietal serous pericardium

Question 20

What is the transverse cavity?

Answer 20

The space dorsal to the aortic and pulmonary arteries and ventral to the superior vena cava.

Question 21

What is the oblique cavity?

Answer 21

The space bordered by the inferior vena cava and the right pulmonary veins of the right and by the left pulmonary veins on the left.

Question 22

Where do the coronary arteries branch off?

Answer 22

The aortic artery

This is a good way to get your bearings when looking at a heart

Question 23

What branches off of the right coronary artery? The left coronary artery?

Answer 23

Right Coronary Artery:
Sinuatrial branch
Right marginal branch
Posterior interventricular

Left Coronary Artery:
Circumflex branch
Left anterior descending branch/anterior interventricular branch
Left marginal branch

Question 24

What veins and arteries of the heart are paired together?

Answer 24

Great cardiac vein: Anterior interventricular artery

Middle cardiac vein: Posterior interventricular artery

Small cardiac vein: Right marginal branch

Question 25

What is the fossa ovale? Why do we have it?

Answer 25

The fossa ovale is a thin wall between the left and right atrium. During fetal development, the fossa ovale opens between the atrium to protect the lungs.

Question 26

What condition can you see with a patent fossa ovale?

Answer 26

Paradoxical embolism

Question 27

What is the significance of the right auricle?

Answer 27

The right auricle is a weaker point of the heart with a lot of hemostasis. Clots can frequently form here.

Question 28

What are the important components of a valve? What do they do?

Answer 28

Leaflets-form the actual flaps of the valve Cordae tendinaea- high tension cords that connect the papillary muscles to the valve Papillary muscles- prevent prolapse or inversion of valve

Question 29

When are all valves closed?

Answer 29

At the beginning of diastole

Question 30

What valves are open during diastole? What valves are closed?

Answer 30

Mitral and Triscuspid valves are open Pulmonary and Aortic valves are closed.

Question 31

What valves are open during systole? What valves are closed?

Answer 31

Pulmonary and Aortic valves are open Mitral and Tricuspid valves are closed?

Question 32

``` What do the following valves connect? Aortic Pulmonary Tricuspid Mitral ```

Answer 32

Aortic opens into aorta from the left ventricle Pulmonary opens into the pulmonary veins from the right ventricle Tricuspid connects the right atrium and the right ventricle Mitral connects the left atrium and the left ventricle

Question 33

(Wigger's Diagram) What causes the atrioventricular valves to close?

Answer 33

When rising ventricular pressure, due to isovolumetric contraction, exceeds atrial pressure.

Question 34

1) What type of valve are the mitral and tricuspid valves called? 2) What type of valve are the aortic and pulmonary valves called?

Answer 34

1) Mitral and tricuspid: Atrioventricular | 2) Aortic and pulmonary: Semilunar

Question 35

What does the P wave of an electrocardiogram represent?

Answer 35

Atrial Depolarization

Question 36

What does the QRS complex of an electrocardiogram represent?

Answer 36

Ventricular Depolarization

Question 37

What does the T wave of an electrocardiogram represent?

Answer 37

Ventricular Repolarization

Question 38

What heart event is not seen on a normal electrocardiogram? Why not?

Answer 38

Atrial Repolarization. It is masked by the larger QRS complex.

Question 39

(Wigger's Diagram) What causes the aortic valve to open?

Answer 39

The aortic valve opens when ventricular pressure exceeds aortic pressure.

Question 40

(Wigger's Diagram) When auscultating the heart, what produces S1? When does this occur in the heart's cycle?

Answer 40

S1 results from the closure of the atrioventricular valves. This occurs at the start of systole.

Question 41

(Wigger's Diagram) When auscultating the heart, what produces S2? When does this occur in the heart's cycle?

Answer 41

S2 results from closure of the semilunar valves. This occurs at the start of diastole.

Question 42

After the aortic valve closes, there is a small, short rise in aortic pressure. What is this called? Why does it occur?

Answer 42

This is called the dicrotic wave. It occurs due to elastic recoil in the aorta following closure of the aortic valve. Note: the dicrotic NOTCH is technically the small DIP in aortic pressure that occurs immediately with aortic valve closure, before the recoil causes the dicrotic wave.

Question 43

Where is the cardiac plexus located?

Answer 43

Near the tracheal bifurcation & the ligamentum arteriosum.

Question 44

Where do postganglionic sympathetic fibers to the heart arise from? Where do their respective preganglionic fibers arise from?

Answer 44

Postganglionic fibers: from the upper sympathetic chain ganglia. Preganglionic fibers: 3 cervical levels and T1-T5.

Question 45

At what levels do afferent fibers from the heart enter the spinal cord? When the heart is in pain, what important clinical finding arises from this fact?

Answer 45

T1-T5. | Referred pain in the region of the left shoulder.

Question 46

Hypertrophy of which chamber of the heart could lead to obstruction of the esophagus?

Answer 46

Left atrium - it is closest to the esophagus.

Question 47

Where in the vascular system is the line used in coronary angioplasty typically inserted into?

Answer 47

The femoral artery.

Question 48

What is important to remember when inserting an autologous vein graft for a coronary bypass surgery?

Answer 48

Veins have valves! Orient the vein so the valves will be open in the direction of arterial blood flow!

Question 49

Which vessel is the most frequent site of coronary artery occlusion?

Answer 49

Left Anterior Descending (LAD) artery / Anterior interventricular branch (of left coronary artery)

Question 50

What artery is the vessel of choice in coronary artery bypass grafting (CABG)?

Answer 50

(Left or Right) Internal Thoracic Artery (previously internal mammary artery)

Question 51

What are some common contributing factors of heart failure?

Answer 51

- Myocardial Infarction - Toxins (e.g. alcohol) - Hypertension - Myocarditis - Idiopathic / Genetic

Question 52

What are some risk factors of coronary atherosclerosis? What is a major problem associated with this condition?

Answer 52

Risk Factors: - Hyperlipidemia - Hypertension - Diabetes - Smoking - Aging Problem: Myocardial Infarction!

Question 53

What pathologic changes to the myocardium might you find in a heart with systolic dysfunction? In what conditions would you see this?

Answer 53

Weak, atrophied, or dead myocardium resulting in a heart not strong enough to pump blood at a sufficient pressure Conditions: Primary dilated cardiomyopathy (CMP), Myocarditis

Question 54

What pathologic changes to the myocardium might you find in a heart with diastolic dysfunction?

Answer 54

Hypertrophied heart muscle that lacks the space to sufficiently fill with blood between contractions Conditions: Hypertrophic cardiomyopathy (CMP), Restrictive CMP, Aging

Question 55

What clinical symptoms might you find secondary to systolic dysfunction?

Answer 55

Signs of inadequate cardiac output: - Fatigue - Cool extremities - Mental obtundation (dullness) - Organ dysfunction (esp. kidneys, liver)

Question 56

What clinical symptoms might you find secondary to LEFT-sided diastolic dysfunction?

Answer 56

Signs of tissue congestion and left ventricular failure: - Dyspnea - Orthopnea (Dyspnea when lying flat) - NO elevation of venous pressure

Question 57

What clinical symptoms might you find secondary to RIGHT-sided diastolic dysfunction?

Answer 57

Signs of tissue congestion and right heart failure: - Cyanosis - Jugular vein engorgement - Liver enlargement - Ascites - Leg edema - ELEVATED venous pressure